Examination Surgery

An indispensible study guide to help surgical trainees prepare and perform for their fellowship exam. Examination Surgery offers invaluable insight into the format and content of the Fellowship Examination in General Surgery. This study guide addresses the most frequently encountered topics from the last 10 years of examinations. It helps surgical trainees organise their studies and optimise their performance in what is reputedly one of the most rigorous postgraduate exams. The general surgery fellowship tests clinical wisdom, judgement, insight and safe practice, and Examination Surgery’s preparation material accurately reflects what you will encounter in the exam. Arranged to mirror the exam’s individual components, Examination Surgery is divided into the following sections: The written papers Clinical viva voces Surgical anatomy viva voce Operative surgery viva voce Pathophysiology and critical care and clinical reasoning viva voce This Elsevier study guide is aimed at candidates preparing for the Fellowship Examination in General Surgery of the Royal Australasian College of Surgeons. It is, however, also relevant for candidates in the UK, Ireland, Canada, South Africa and Hong Kong, plus all general surgeons, surgical residents and medical students. By Christopher J Young, MBBS MS FRACS, Clinical Associate Professor, Central Clinical School, University of Sydney, Australia Head of Unit, Royal Prince Alfred Hospital Colorectal Unit, Sydney, Australia Visiting Medical Offi cer General and Colorectal Surgery, Royal Prince Alfred and Concord Hospitals Chairman, Royal Australasian College of Surgeons Board In General Surgery and Marc A Gladman, MBBS DRCOG DFFP PhD MRCOG MRCS (Eng) FRCS (Gen Surg, UK) FRACS, Professor of Colorectal Surgery, Concord Clinical School, School of Medicine, University of Sydney, Australia Head of Academic Colorectal Unit and Consultant Colorectal Surgeon, Concord Hospital, Sydney, Australia Director, Enteric Neuroscience & Gastrointestinal Research Group, ANZAC Research Institute, University of Sydney, Australia Table of Contents: Section 1 Examination information and preparation Chapter 1.1 Basic examination requirements and organisation The Fellowship in Australasia The Intercollegiate Specialty Examination in General Surgery in the UK and Ireland Chapter 1.2 Preparation for the fellowship examination Plan, prepare and practise Awareness of the aims, format and marking scheme of the Examination Syllabus of the Fellowship exam (FRACS only) Structure, structure, structure Summary/key points Chapter 1.3 Important topics for the fellowship examination Written paper 1 Written paper 2 Clinical viva 1 Clinical viva 2 Chapter 1.4 Suggested reading list What to read? So many books, so little time! Written examinations 1 and 2 Clinical vivas Anatomy viva Operative viva Pathophysiology and critical care and clinical reasoning viva General reading Section 2 The written papers Chapter 2.1 The written examination paper 1 - spot test questions The examination format Exam technique Preparation and practising Chapter 2.2 Common written examination spot test questions: model answers 2.2.1 Scrotal swelling 2.2.2 Breast cancer. 2.2.3 Bilateral gynaecomastia 2.2.4 Paget’s disease of the nipple 2.2.5 Rectal cancer 2.2.6 Clostridium difficile colitis 2.2.7 Colitis 2.2.8 Large bowel obstruction 2.2.9 Rectal prolapse 2.2.10 Appendiceal mucocoele 2.2.11 Fistula in ano 2.2.12 Fissure-in-ano 2.2.13 Anal squamous cell carcinoma 2.2.14 Small bowel obstruction 2.2.15 Meckel’s diverticulum 2.2.16 Gastrointestinal stromal tumour 2.2.17 Parathyroid adenoma 2.2.18 Pancreatic cystic lesion 2.2.19 Submandibular duct stone 2.2.20 Malignant melanoma 2.2.21 Basal cell carcinoma 2.2.22 Squamous cell carcinoma 2.2.23 Lymphoscintogram 2.2.24 Pelvic fracture 2.2.25 Splenic trauma 2.2.26 Seatbelt injury 2.2.27 Barium swallow: oesophageal cancer and achalasia 2.2.28 Gastric ulcer 2.2.29 Choledochal cyst 2.2.30 Pancreatic pseudocyst 2.2.31 Diabetic foot 2.2.32 Ischaemic leg 2.2.33 Psoas abscess Chapter 2.3 The written examination paper 2 - short answer questions The examination format Exam technique Preparation and practising Chapter 2.4 Common written examination short answer questions 2.4.1 Genetics of colorectal cancer syndromes 2.4.2 Autonomic innervation of the pelvis 2.4.3 Management of large bowel obstruction/role of colonic stents 2.4.4 Colonoscopic surveillance and complications 2.4.5 Enterocutaneous fistula 2.4.6 Solitary thyroid nodules 2.4.7 Thyrotoxicosis 2.4.8 Primary hyperparathyroidism 2.4.9 Phaeochromocytoma 2.4.10 Anterior and posterior neck triangles 2.4.11 Laparostomy 2.4.12 Malignant melanoma 2.4.13 Renal transplantation: short- and long-term complications 2.4.14 Blunt abdominal injury 2.4.15 Burns 2.4.16 Gastro-oesophageal refl ux disease 2.4.17 Obesity/bariatric surgery 2.4.18 Upper GI haemorrhage 2.4.19 Complications after laparoscopic cholecystectomy 2.4.20 Solid liver lesions 2.4.21 Pancreatic mass 2.4.22 Venous thromboembolism prophylaxis 2.4.23 Leg ulcers 2.4.24 Needle stick injury Section 3 The clinical examination Chapter 3.1 An approach to the clinical examination The examination format Exam technique Preparation and practising Chapter 3.2 The medium case clinical examination The examination format Exam technique Preparation and practising Chapter 3.3 Common medium cases 3.3.1 Breast cancer 3.3.2 Rectal cancer 3.3.3 Colon cancer 3.3.4 Ulcerative colitis 3.3.5 Oesophageal carcinoma 3.3.6 Chronic liver disease 3.3.7 Liver metastases 3.3.8 Abdominal mass 3.3.9 Malignant melanoma Chapter 3.4 The short case clinical examination The examination format Exam technique Preparation and practising Chapter 3.5 Common short cases 3.5.1 Inguinal hernia 3.5.2 Incisional hernia 3.5.3 Goitre 3.5.4 Parotid mass 3.5.5 Neck lymphadenopathy 3.5.6 Dupuytren’s contracture 3.5.7 Leg ulcers 3.5.8 Peripheral occlusive arterial disease 3.5.9 Lymphoedema 3.5.10 Varicose veins 3.5.11 Median nerve palsy 3.5.12 Ulnar nerve palsy 3.5.13 Abdominal mass Section 4 The viva voce examination Chapter 4.1 Surgical anatomy The examination format Exam technique Preparation and practising Chapter 4.2 Common surgical anatomy viva topics: model answers 4.2.1 Extraperitoneal inguinal region anatomy 4.2.2 Axillary anatomy 4.2.3 Thyroidectomy anatomy 4.2.4 Parotid gland anatomy and relations 4.2.5 Submandibular gland and relations 4.2.6 Blood supply of the stomach 4.2.7 Cholecystectomy anatomy 4.2.8 Intra-operative cholangiogram 4.2.9 Liver anatomy 4.2.10 The pancreas and its relations 4.2.11 Superfi cial venous system of the lower limb 4.2.12 The parathyroid glands 4.2.13 Median nerve 4.2.14 Ulnar nerve 4.2.15 Femoral triangle 4.2.16 Popliteal fossa 4.2.17 Branches of the abdominal aorta 4.2.18 Diaphragm 4.2.19 Retroperitoneal anatomy 4.2.20 Transpyloric plane 4.2.21 Transtubercular plane 4.2.22 Internal iliac artery branches Chapter 4.3 Operative surgery The examination format Exam technique Preparation and practising Chapter 4.4 Common operative surgery viva topics: model answers 4.4.1 Inguinal hernia repair 4.4.2 Complicated femoral hernia repair 4.4.3 Axillary dissection 4.4.4 Ileostomy closure 4.4.5 Right hemicolectomy/caecal volvulus 4.4.6 Hartmann’s procedure 4.4.7 Haemorrhoidectomy 4.4.8 Small bowel resection 4.4.9 Thyroglossal cysts 4.4.10 Submandibular gland excision 4.4.11 Tracheostomy 4.4.12 Trauma laparotomy 4.4.13 Perforated peptic ulcer 4.4.14 Intra-operative management of common bile duct stones 4.4.15 Trauma splenectomy 4.4.16 High ligation of the long saphenous vein Chapter 4.5 Pathophysiology and critical care/clinical reasoning The examination format Exam technique Preparation and practising Chapter 4.6 Pathophysiology and critical care/clinical reasoning viva topics: model answers 4.6.1 Synoptic breast pathology reporting 4.6.2 Colonic polyps 4.6.3 Crohn’s disease 4.6.4 Carcinoid of the appendix 4.6.5 Fistula-in-ano 4.6.6 Pilonidal sinus 4.6.7 Small bowel tumours 4.6.8 Thyroid cancer 4.6.9 Multinodular goitre 4.6.10 Adrenal tumours 4.6.11 Systemic infl ammatory response syndrome 4.6.12 Multi-organ dysfunction syndrome 4.6.13 Necrotising soft tissue infections 4.6.14 Mesenteric ischaemia 4.6.15 Testicular tumours 4.6.16 Tension pneumothorax 4.6.17 Barrett’s oesophagus 4.6.18 Oesophageal cancer 4.6.19 Stomach cancer 4.6.20 Hydatid cyst 4.6.21 Pancreatitis 4.6.22 Anticoagulation